Low genetic confirmation rate in South Indian subjects with a clinical diagnosis of maturity-onset diabetes of the young (MODY) who underwent targeted next-generation sequencing for 13 genes

PURPOSE

To screen for maturity-onset diabetes of the young (MODY) variants in subjects with an early age of onset and positive family history of diabetes mellitus.

METHODS

60 subjects with onset of diabetes between 3 and 30 years of age and parental history (onset < 35 years) of diabetes were recruited after excluding autoimmune, pancreatic and syndromic forms of diabetes. Detailed pedigree chart and clinical data were recorded. MODY genetic testing (MODY 1-13) was performed and variant classification was done adhering to the ACMG guidelines.

RESULTS

Baseline characteristics of subjects were as follows: mean age of onset of diabetes 19.9 ± 7 years, mean duration of diabetes 6.3 ± 6.8 years, BMI 23.3 ± 3 kg/m² and C-peptide 1.56 ± 1.06 nmol/l. Four out of sixty (6.6%) were positive for variants classifiable as pathogenic/likely pathogenic: one patient with HNF4Ac.691C > T, (p.Arg231Trp), two with HNF 1A c.746C > A(p.Ser249Ter) and c.1340C > T(p.Pro447Leu), and one with ABCC8 c.4544C > T (p.Thr1515Met). MODY 1 and MODY 3 variants were documented in the paediatric age group (< 18 years).

CONCLUSION

A genetic diagnosis of MODY could be confirmed in only 6.6% (4/60) of patients clinically classifiable as MODY. This is less than that reported in clinically diagnosed MODY subjects of European descent. Newly published population data and more stringent criteria for assessment of pathogenicity and younger age of onset of type 2 diabetes in Indians could have contributed to the lower genetic confirmation rate. Apart from variants in the classical genes (HNF1A, HNF4A), a likely pathogenic variant in a non-classical gene (ABCC8) was noted in this study.

Bilateral syndactyly of both extremities in a new born - a case report

Syndactyly is a condition where in two or more digits are fused together. A newborn female baby showed not only webbing of the fingers but also toes. X-ray of both hands and feet showed no bony fusion. Syndactyly is a rare anomaly that has surgical and psychological implications. Normally mesenchyme between prospective digits in hand and foot plates is removed by cell death (apoptosis) when this process fails the result is fusion between two or more digits. It occurs as one in every 2000 to 2500 births and twice as common in males. Though it is very rare it can be corrected surgically and child can live a normal life. The knowledge of digit formation and causes for abnormalities in the digits and toes are important for radiologists, obstetricians and surgeons for accurate diagnostic interpretation.

Two novel AIRE mutations in autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) among Indians

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare recessive disorder resulting from mutations in the autoimmune regulator (AIRE) gene. There is no information on AIRE mutations in Indians. In a cross-sectional study, nine patients (eight families), from four referral hospitals in India, were studied for AIRE mutations by direct sequencing. We screened for new mutations in 150 controls by allele-specific PCR. The patients had 1-7 known components of APECED. Three patients had unusual manifestations: presentation with type 1 diabetes; chronic sinusitis and otitis media; and facial dysmorphism. All patients carried homozygous, probably recessive, AIRE mutations. Two unrelated patients from a small in-bred community (Vanika Vaisya) in south India carried an unreported missense mutation, p.V80G, in the N-terminal caspase recruitment domain. Another unique mutation, p.C302X, resulting in a truncated protein with deletion of both zinc-finger domains, was detected in a patient from Gujarat. Neither mutation was detected in controls. Other mutations, previously described in Caucasians, were: 13 base pair deletion (p.C322fsX372) in 4 (38%), and Finn-major (p.R257X) and p.R139X (Sardinian) mutation in one subject each. In conclusion, in this first series of APECED in Indians, we detected AIRE mutations previously reported in Caucasians, as well as unique mutations. Of these, p.V80G is possibly an ancestral mutation in an in-bred community.

Stereoselective synthesis and stereochemistry of r-2-alkoxycarbonyl-c-3-o-substituted phenyl-1,4-thiazane 1,1-dioxides

r-2-Alkoxycarbonyl-c-3-aryl-1,4-thiazane 1,1-dioxides were obtained as the stereoselective product, when the aldehyde used was o-substituted benzaldehyde while the p-substituted benzaldehydes gave a trans product. The relative configuration of the adjacent alkoxycarbonyl and aryl groups was assigned from the vicinal coupling constant, 3J = 10.6 Hz in the trans isomer and 3.2 Hz in the cis isomer, and from the multiplicity pattern, i.e., a doublet for the H-2 proton of the trans isomer and a triplet for the H-2 proton of the cis isomer. The unusual, large long-range coupling (4J = 2.8 Hz) because of the "W" arrangement between H-2e and H-6e across the ring type was very useful for confirming the cis configuration and chair conformation of the isomer. The various 1H and 13C NMR assignments were made with the help of 1H–1H COSY, 1H–13C COSY, HMBC, and NOESY spectral analyses.Key words: 1H and 13C NMR, 1H–1H COSY, 1H–13C COSY, HMBC, NOESY, stereoselectivity, 1,4-thiazane.